Unifying Concepts

Diagnostic Criteria for Orthorexia

Orthorexia nervosa describes a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Although prompted by a desire to achieve optimum health, orthorexia may lead to nutritional deficiencies, medical complications, and poor quality of life.

Diagnostic Criteria for Orthorexia

Criterion A: Obsessional preoccupation with eating “healthy foods,” focusing on concerns regarding the quality and composition of meals. (Two or more of the following.)

  • Consuming a nutritionally unbalanced diet owing to preoccupying beliefs about food “purity.”
  • Preoccupation and worries about eating impure or unhealthy foods and of the effect of food quality and composition on physical or emotional health or both.
  • Rigid avoidance of foods believed by the patient to be “unhealthy,” which may include foods containing any fat, preservatives, food additives, animal products, or other ingredients considered by the subject to be unhealthy.
  • For individuals who are not food professionals, excessive amounts of time (eg., 3 or more hours per day) spent reading about, acquiring, and preparing specific types of foods based on their perceived quality and composition.
  • Guilty feelings and worries after transgressions in which “unhealthy” or “impure” foods are consumed.
  • Intolerance to other’s food beliefs.
  • Spending excessive amounts of money relative to one’s income on foods because of their perceived quality and composition.

Criterion B: The obsessional preoccupation becomes impairing by either of the following:

  • Impairment of physical health owing to nutritional imbalances (eg., developing malnutrition because of an unbalanced diet).
  • Severe distress or impairment of social, academic, or vocational functioning owing to obsessional thoughts and behaviors focusing on patient’s beliefs about “healthy” eating.

Criterion C: The disturbance is not merely an exacerbation of the symptoms of another disorder such as obsessive-compulsive disorder or of schizophrenia or another psychotic disorder.

Criterion D: The behavior is not better accounted for by the exclusive observation of organized orthodox religious food observance or when concerns with specialized food requirements are in relation to professionally diagnosed food allergies or medical conditions requiring a special diet.



  1. Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P. Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. 2015 Jul-Aug;56(4):397-403. [Medline]
  2. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015 Feb 18;11:385-94. [Medline]


Created Dec 26, 2022.

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